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ISSN: 2168-9857 ogy Medical & Surgical Urology Case Report

Benign Prostatic Hyperplasia in 69 Years Old Man with Highest Serum PSA
Level >3500 ng/mL
Fouad Kolawalé Yde Soumanou1*, Josué Dédjinin Georges Avakoudjo2, Dètondji Fred Hodonou3,
Khadidjatou Ouake4
1Department of Urology, University Hospital of CNHU-HKM (Clinical and etiological aspects of sciatica in Hubert Koutoukou
Maga Teaching Hospital), Cotonou, Benin; 2Surgery Department, University Hospital of CHU S/L, Cotonou, Benin; 3Department
Urology, University Hospital of CNHU-HKM, Cotonou, Benin; 4Surgery Department, Hospital De Zone Suru Lere, Cotonou, Benin

ABSTRACT
Objective: To describe a case of 69 years old man who had Benign Prostatic Hyperplasia (BPH) with highest serum
Prostate Specific Antigen (PSA) (>3500 ng/mL).
Materials and Methods: This is a case report of elevated PSA in 69 years old man with BPH.
Results: We were reported a 69 years-old man who was admitted for low urinary tract symptoms. In medical history,
we were found PCa (Prostate Cancer) case in his family. Digital Rectal Examination (DRE) found soft, enlarged,
smooth prostate. Serum PSA level was highest (>3500 ng/mL). Computed tomography chest-abdominal-pelvic
revealed: integrity of prostate capsule and bladder decompensation; neither iliac-inguinal lymph nodes nor bones
damage were not found. Transrectal ultrasound prostate biopsy realized. Anatomopathological screening prostate
biopsy was negative. Anatomopathological screening of prostatectomy piece confirmed BPH. Serum PSA test done
two weeks later. The result was 0.48 ng/mL.
Conclusion: Serum PSA test can misleading. Elevated serum PSA can be associated with BPH.
Keywords: PSA; Prostate cancer; Benign prostatic hyperplasia

INTRODUCTION CLINICAL CASE

Older men usually have a shorter life expectancy, a higher risk of
competing causes of mortality, and a greater risk of potential
harm from screening for prostate cancer (PCa) [1]. It is evident
that there is an increasing proportion of individuals aged 70
years and older, as well as an increasing life expectancy
worldwide [2]. Although use of the Prostate Specific Antigen
(PSA) as a diagnostic marker has improved the detection of PCa,
its low sensitivity and specificity for PCa makes early finding of
PCa difficult. PSA level is frequently increase in Benign Prostatic
Hyperplasia (BPH) [3].
We described a case report of elevated serum PSA in 69 years
old man with BPH.
A 69-years-old man was admitted for difficult voiding,
marcroscopic haematuria and irritative voiding symptoms. The
symptoms were started since 5 years. International Score of
Prostatic Symptom (IPSS) was 25 (severe symptom). Medical
prescription was alpha-blocker. He had hypertension and
diabetes in past history. His father died of prostate cancer.
General state was satisfactory. Digital rectal examination found
soft, smooth, enlarged and painless prostate. Serum PSA test was
done in three various hospital and level was >3500 ng/mL.
Sonogram found prostate of 152 g of weight, middle lobe
enlargement and bladder decompensation.
Computed tomography chest-abdominal-pelvic revealed: integrity
of prostate capsule and bladder decompensation; neither iguinal-
iliac lymph nodes nor bones damage were not found; prostate

*Correspondence to: Fouad Kolawalé Yde Soumanou, Department Head of Urology, University Hospital of CNHU-HKM, Cotonou, Benin, Tel:
00229 96880788; E-mail: soumfou@yahoo.fr
Recieved: March 19, 2019, Accepted: April 2, 2019, Published: April 9, 2019
Citation: Soumanou FKY, A vak oudjo JDG, Hodonou DF , Ouake K (2019) Benign Prostatic Hyperplasia in 69 Years Old Man with Highest
Serum PSA Level >3500 ng/mL. Med Sur Urol 8:219. doi: 10.24105/2168-9857.8.219
Copyright: © 2019 Soumanou FKY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Med Sur Urol, Vol.8 Iss.2 No:219 1

Soumanou FKY, et al.
volume was 140 g. Transrectal ultrasound prostate biopsy done.
Anatomopathological screening of prostate biopsy was negative.
Urine culture identified enterocoque bacterium sensible to these
antibiotics groups: Aminoglycoside and ß-lactamine.
Prostatectomy was successfull realized. Prostate weight was 120 g.
Postoperative aftercare were simple. Anatomopathological
screening of prostatectomy piece confirmed benign prostatic
hyperplasia. Serum PSA test done two weeks later. The result
was 0.48 ng/mL. IPSS was 3.
DISCUSSION
Serum Prostate-Specific Antigen (PSA) is one of the most
influential and controversial biomarkers in oncology. Although
using PSA for screening and the early detection of prostate
cancer (PCa) is hotly debated, using PSA is not as controversial
in patients with a known diagnosis of PCa. We would argue that
an overreliance on PSA in a patient with a known diagnosis of
PCa can lead to suboptimal care through unnecessary and
potentially harmful treatments and early discontinuation of
potentially helpful treatments [4]. PSA is one of several factors
(PSA kinetics, American Joint Committee on Cancer staging,
Gleason score, and patient characteristics) used to guide staging
and treatment decisions for men with newly diagnosed disease
[5]. Despite these valuable contributions of the PSA test after a
PCa diagnosis, PSA has significant limitations that often are not
discussed [6].
Second-generation PSA tests have better diagnostic accuracy for
high-grade disease than earlier tests. Two such tests, the Prostate
Health Index (Beckman Coulter) and the 4Kscore (Opko
Health), are commercially available though not usually covered
by commercial insurers. A third test, IsoPSA (Clevel and
Diagnostics), is under development [7].
A PSA Volatility Index (PVI) was used to assess PSA variability
over time. A high PVI derived from a highly variable PSA with a
flat or negative PSA slope and predicted for BPH. In contrast, a
low PVI predicted for PCa and derived from PSAs which
trended upward with little variation around the regression. PVI
is a useful method to assess for prostate cancer risk in men with
highly variable PSAs over >6 months study time [8].
There is, therefore, an urgent need for novel biomarkers that
can effectively distinguish PCa from BPH. PSA, and PDW
(Platelet Distribution Width) are markedly higher and MPV
(Mean Platelet Volume) is significantly reduced in PCa patients
than in BPH patients [3]. In addition, PSA, MPV, and PDW in
combination significantly enhance the ability to distinguish PCa
from BPH. Recent studies confirmed that low levels of MPV are
associated with high-grade inflammatory diseases and reverse in
the course of anti-inflammatory therapy [9]. Aksoy et al. [10]
observed that solid tumors with bone marrow metastasis were
more likely to have low MPV levels. On the other hand, high
PSA levels are frequently detected in BPH patients [11].
Therefore, identification of new biomarkers to correctly identify
Med Sur Urol, Vol.8 Iss.2 No:219
PCa patients would help to prevent individuals with BPH from
getting unnecessary biopsies and from the side effects of
overtreatment [3].
CONCLUSION
Serum PSA test can misleading. Anatomopathological screening
of prostate biopsy was negative. Anatomopathological of
prostatectomy piece confirmed BPH. Elevated serum PSA can
be associated with BPH.
CONFLICT OF INTEREST
None
SOURCE OF FUNDING
None
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